Organization
MODERN DENTAL PROFESSIONALS, MINNESOTA PC
Active
Other names
Midwest Dental
Organization subpart
No
Provider details
NPI number
Authorized official
LORI PELKE (PROFESSIONAL SERVICES COORDINATOR)
(715) 926-5050
Entity
Organization
Contact information
Practice address
931 WHITEWATER AVE, SAINT CHARLES, MN 55972-1130
(507) 932-4530
Mailing address
680 HEHLI WAY, MONDOVI, WI 54755-1639
(715) 926-5050
(715) 926-4269
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Enumeration date
03/31/2009
Last updated
03/31/2009
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